By GARRY RAYNO, InDepthNH.org

CONCORD — Staffing long-term care facilities was a challenge before the coronavirus pandemic but is now a critical issue, a legislative study committee was told Thursday.

Facility representatives spoke to the Committee to Study the Safety of Residents and Employees in Long-Term Care Facilities saying there are things the state could do to help. 

The problem is two-fold, not enough people are being trained to be health-care workers and wages that facilities pay are too low to compete with other employers, they told the committee.

The COVID-19 pandemic has devastated many of the state’s long-term care facilities, affecting both residents and staff.

To date, 363 of the state’s 446 deaths from the pandemic, or 81.4 percent, have been in long-term care facilities including nursing homes.

Thomas Blonski, president and CEO of NH Catholic Charities, said the state’s low Medicaid reimbursement rates for nursing homes may cause many facilities “to die on the vine.”

He said his organization loses $45 a day per patient for Medicaid patients, and they represent 80 percent of the organization’s patients.

“New Hampshire is at the bottom of the heap in funding for nursing home residents,” Blonski said. “Without CARES Act dollars, our losses would be in excess of $5 million.” He said nursing homes need good testing, ample personal protection equipment and a sufficient Medicaid rate to pay staff “the dignity of a living wage.”

The committee chair state Sen. Jon Morgan, D-Brentwood, said the committee heard Blonski’s concerns.

“Increased Medicaid rates and the dignity of a livable wage would go a long way to be supportive for long-term care facilities,” he said, “and to attract and maintain staff.”

He noted the staffing issues is not a single isolated event and said that is an area the committee intends to acknowledge and address in its final report.

Cathy Gray, president and CEO of Cedarcrest Center for Children with Disabilities in Keene, said a recent statewide staffing survey of long-term care facilities showed hundreds of job openings for trained and certified health-care workers reflecting shortages of 22 to 25 percent depending on the nursing certification level.

Those numbers are not 100 percent accurate, she said, because many facilities use “traveling staff” who go from place to place.

Gray said her facility uses a traveling nurse to cover the overnight shift, noting it pays a premium for the traveling nurse.

“You take out the travelers and these numbers would be much worse,” Gray said.

The survey does not include hospitals or home care organizations, which do their own surveys later in the year, Gray said, which will provide a bigger picture of how short nursing help is in the state.

“The situation is critical,” she said.

Another problem, Gray noted, is licensed nursing facilities cannot have nursing students in their facilities to do their clinical training. She said that is national guidance through the state public health agency on essential workers.

Not only do the students not experience hands-on care, it also hurts the facilities’ ability to recruit those students for employment.

“Not allowing students access to these buildings is shortchanging future caregivers,” Gray said. “There is nothing like being directly engaged with a patient, having that exchange is a critical part of education and a critical part of recruiting.”

The Red Cross used to train a large number of nurses, but decided to end that program, Gray said, noting the organization was the primary trainer for many facilities in the Monadnock region.

She said a private agency is trying to place students in facilities, the community colleges in Manchester and the Upper Valley have licensed nursing assistants programs, and high school career centers offer a two-year program.

But she said the need is great and has been for some time but has been exacerbated by the COVID-19 pandemic.

The pandemic has also increased costs exponentially for PPE and cleaning supplies and for testing staff, Gray said.

The state is now transitioning to private testing for long-term care facilities, who now will have to contract with a lab, she said.

The state will reimburse $100 per test but they cost $175 for smaller facilities that are not large enough to receive a discount, Gray said.

She also noted the low state Medicaid reimbursement rates, saying it would be difficult for facilities to absorb the testing costs when they are not able to utilize all their existing beds because they do not have enough staff.

“They do not have the income they need to cover their costs,” Gray said. “Some private facilities are in a horrible situation. How far into reserves can you go?”

Alan Bernard, assistant vice president for healthcare services for Catholic Charities also told of greatly increased prices for PPE, noting early on some of the orders were being confiscated by the federal government for the national stockpile.

Unless you ordered large quantities, you paid an inflated price, he said.

Finding the staffing is challenging, Bernard said, and compounded by the pandemic as some staff left the industry because they had preexisting conditions or someone in their family did.

And the negative publicity nationally makes it difficult to recruit staff, Bernard said. “Our greatest challenge in attracting staff is eliminating fears of working in a long-term care facility.”

Catholic Charities had an outbreak at its Mount Carmel facility in Manchester in the early stages of the pandemic when the virus was overwhelming New York, Massachusetts, Connecticut and southern New Hampshire, said Darlene Underhill, director of clinical services.

At that time it was almost impossible to test staff or residents, she noted, and one staff member did not tell supervisors he had a sore throat and the virus spread throughout the facility to residents and staff.

The state began a program to test all staff and residents of long-term care facilities, and the numbers started decreasing rapidly, Underhill said.

She said the Center for Medicare and Medicaid Services will only support testing once a month, and care providers will be responsible for additional testing.

“That is a big concern,” Underhill said.

The committee also heard from New Hampshire Veterans’ Home Commandant Peggy LeBrecque, who told the committee they have been very fortunate the facility has not had anyone test positive.

The committee meets again Oct. 15 at 8 a.m. and will then begin drafting its final report.

Garry Rayno may be reached at garry.rayno@yahoo.com.